Need More Study on Concussions, IOM Says

WASHINGTON -- A number of authoritative bodies ranging from the CDC to the National Collegiate Athletic Association (NCAA) should develop, implement, and evaluate large-scale efforts to increase knowledge about concussions, an expert panel recommended.

Little is known about the number of sports-related concussions, the efficacy of newer imaging techniques, and optimization of treatment plans, the Institute of Medicine (IOM) and National Research Council (NRC) said Wednesday.

"Many studies have small sample sizes and methodological weaknesses that limit the validity of their findings," the report, funded by the CDC Foundation and the National Football League, found. "However, the committee determined that even studies of limited strength could provide some useful information and inform future research needs."

The IOM and NRC made recommendations aimed at research-funding agencies, legislatures, state and school superintendents, and athletic bodies and officials. The expert panel convened last October to review available literature on concussion's impact, treatment, and long-term consequences. The panel held a 2-day workshop in February.

"It is clear to us that currently, in many settings, the seriousness of the threat to the health of an athlete, both acute and long term, from suffering a concussion is not fully appreciated or acted upon," the report, "Sports-Related Concussions in Youth: Improving the Science, Changing the Culture," stated. "Too many times the committee read or heard first-person accounts of young athletes being encouraged by coaches or peers to 'play through it.'"

From a provider's perspective, the committees found newer imaging techniques for evaluating possible concussions may be useful in the future, but haven't been proven for clinical use. Those images can detect differences in concussed versus nonconcussed youth when behavior measures fail.

Furthermore, the use of serum biomarkers in children has also been studied little, the report found.

Additional knowledge is needed on the how best to optimize individual treatment plans, such as rest to allow the brain to recover before returning to play.

"Randomized controlled trials or other appropriately designed studies on the management of concussion youth are needed in order to develop empirically based clinical guidelines," the IOM and NRC recommended.

Studies include those to determine proper physical and cognitive rest following concussions and the best protocol for returning individuals to full physical activity.

The report offered several recommendations, including:

The CDC should establish and oversee a national surveillance system to determine concussion's incidence.

The National Institutes of Health should support research that creates age-specific, evidence-based guidelines for concussion management in youth.

The NIH and Defense Department should conduct longitudinal studies to assess the short- and long-term consequences of concussions.

The NCAA, with other athletic governing bodies, should undertake a rigorous scientific evaluation of age-appropriate techniques, rules, and playing standards.

The NCAA, CDC, Education Department, and others should develop, implement, and evaluate large-scale efforts to increase knowledge about concussions.

An estimated 1.6 million to 3.8 million sports- and recreation-related traumatic brain injuries, including concussions and other head injuries, occur in the U.S. each year, the report found.

But that number is hard to pinpoint, in part because of the lack of a clear definition and lack of data-gathering. Furthermore, providers do not routinely gather information on race, ethnicity, or socioeconomic status of participants.

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.